Millions of the neediest Americans will get a nasty surprise after July 1, unless something is done to ease them through a potentially difficult transition.

The federal Deficit Reduction Act, which President Bush signed in February, includes a provision aimed at keeping non-citizens ineligible for Medicaid, off the rolls. That's fine, but the collateral casualties are sure to include qualifying American households, caught unaware by a new requirement: They must submit documents proving their citizenship when first applying or when renewing their Medicaid benefits.

In Hawai'i, the state Department of Human Services is working with agencies that deal with the Medicaid population to get the word out: People won't receive benefits unless the provide either an original birth certificate or a passport. That's the right approach; unfortunately, there's not enough of that happening elsewhere.

Unless there's an extension, Medicaid recipients, many of whom can secure these documents only with difficulty or significant expense, could see their benefits lapse until they comply. The ones most likely to suffer include the disabled, the mentally ill, the homeless, elderly and chronically ill — all at risk because most don't have a passport and need more time to get copies of birth certificates.

The state should continue its own outreach efforts in the event the deadline stands. It also would be a good idea to waive processing fees for birth certificates and give these applications top priority.

It's sensible to curb spending by making sure those who receive benefits are qualified. But government must be careful not to place unfair barriers in the pathway of people who need its protection the most.